Provider Demographics
NPI:1851779318
Name:GLEICHGERRCHT, EZEQUIEL LEONARDO (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:EZEQUIEL
Middle Name:LEONARDO
Last Name:GLEICHGERRCHT
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 EXECUTIVE PARK DR NE STE 250
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2206
Mailing Address - Country:US
Mailing Address - Phone:404-778-3444
Mailing Address - Fax:
Practice Address - Street 1:12 EXECUTIVE PARK DR NE STE 250
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2206
Practice Address - Country:US
Practice Address - Phone:404-778-3444
Practice Address - Fax:404-778-3444
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC380512084N0400X, 208D00000X
GA948642084N0400X, 2084N0600X, 2084E0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice